Changes to MBS Items for Spinal Surgery Services – Claiming Examples Last updated: 12/10/2018

Effective from 1 November 2018

Lumbar microdiscectomy (or discectomy) including recurrent disc prolapseOne motion segment: 51011

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51011 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,435.50Benefit: 75% = $1,076.65

Two motion segments: 51012Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51012 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, 2 motion segments, not being a service associated with a service to which item 51011, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,913.80Benefit: 75% = $1,435.35

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 1 of 16MBSOnline

Lumbar laminectomy or laminotomy for lumbar canal stenosisStenosis at one motion segment: 51011

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51011 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,435.50Benefit: 75% = $1,076.65

Stenosis at two motion segments: 51012Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51012 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, 2 motion segments, not being a service associated with a service to which item 51011, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,913.80Benefit: 75% = $1,435.35

Stenosis at three motion segments: 51013Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51013 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, 3 motion segments, not being a service associated with a service to which item 51011, 51012, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $2,392.25Benefit:75% =$1,794.18

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 2 of 16MBSOnline

Anterior cervical decompression and fusion with internal fixation (ACDF) for nerve root compression or spinal cord compressionDecompression and fusion at one motion segment:

51011 + 51021 + 51041 (+ 51120)Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51011 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,435.50Benefit: 75% = $1,076.65

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51021 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, one motion segment, not being a service associated with a service to which item 51020, 51022, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,281.20Benefit:75% =$960.90

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51041 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), one motion segment, not being a service associated with a service to which item 51042, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,082.70Benefit:75% =$812.05

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 3 of 16MBSOnline

Decompression and fusion at two motion segments: 51012 + 51022 + 51042 (+ 51120)

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51012 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, 2 motion segments, not being a service associated with a service to which item 51011, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,913.80Benefit: 75% = $1,435.35

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51022 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, 2 motion segments, not being a service associated with a service to which item 51020, 51021, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,593.70Benefit:75% =$1,195.30

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51042 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), 2 motion segments, not being a service associated with a service to which item 51041, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,515.80Benefit:75% =$1,136.85

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 4 of 16MBSOnline

Posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with internal fixation and posterolateral fusion, for nerve root compression or lumbar canal stenosisFusion at one motion segment:

51011 + 51021 + 51041 (+ 51031, + 51120)Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51011 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,435.50Benefit: 75% = $1,076.65

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51021 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, one motion segment, not being a service associated with a service to which item 51020, 51022, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,281.20Benefit:75% =$960.90

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51041 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), one motion segment, not being a service associated with a service to which item 51042, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,082.70Benefit:75% =$812.05

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51031 Spine, posterior and/or posterolateral bone graft to, one motion segment,

not being a service associated with a service to which item 51032, 51033, 51034, 51035 or 51036 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.144

Multiple operations rule

Fee: $941.45Benefit:75% =$706.10

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 5 of 16MBSOnline

Fusion at two motion segments: 51012 + 51022 + 51042 (+ 51032, + 51120)

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51012 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, 2 motion segments, not being a service associated with a service to which item 51011, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,913.80Benefit: 75% = $1,435.35

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51022 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, 2 motion segments, not being a service associated with a service to which item 51020, 51021, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,593.70Benefit:75% =$1,195.30

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51042 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), 2 motion segments, not being a service associated with a service to which item 51041, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,515.80Benefit:75% =$1,136.85

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51032 Spine, posterior and/or posterolateral bone graft to, 2 motion segments, not

being a service associated with a service to which item 51031, 51033, 51034, 51035 or 51036 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.144

Multiple operations rule

Fee: $1,129.75Benefit:75% =$847.30

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 6 of 16MBSOnline

Anterior lumbar interbody fusion (ALIF) with internal fixation, including XLIF or OLIF – single surgeonFusion at one motion segment:

51021 + 51041 + 51160 (+ 51120)Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51021 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, one motion segment, not being a service associated with a service to which item 51020, 51022, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,281.20Benefit:75% =$960.90

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51041 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), one motion segment, not being a service associated with a service to which item 51042, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,082.70Benefit:75% =$812.05

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51160 Anterior exposure of thoracic or lumbar spine, one motion segment, not

being a service to which item 51165 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.149

Multiple operations rule

Fee: $1,150.00Benefit:75% =$862.50

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 7 of 16MBSOnline

Fusion at two motion segments:51022 + 51042 + 51165 (+ 51120)

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51022 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, 2 motion segments, not being a service associated with a service to which item 51020, 51021, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,593.70Benefit:75% =$1,195.30

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51042 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), 2 motion segments, not being a service associated with a service to which item 51041, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,515.80Benefit:75% =$1,136.85

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery Fee51165 Anterior exposure of thoracic or lumbar spine, more than one motion

segment, not being a service to which item 51160 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.149

Multiple operations rule

Fee: $1,450.00Benefit:75% =$1,087.50

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 8 of 16MBSOnline

Fusion at three motion segments:51023 + 51043 + 51165 (+ 51120)

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51023 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, 3 or 4 motion segments, not being a service associated with a service to which item 51020, 51021, 51022, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,896.60Benefit:75% =$1,422.45

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51043 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), 3 motion segments, not being a service associated with a service to which item 51041, 51042, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,894.75Benefit:75% =$1,421.10

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery Fee51165 Anterior exposure of thoracic or lumbar spine, more than one motion

segment, not being a service to which item 51160 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.149

Multiple operations rule

Fee: $1,450.00Benefit:75% =$1,087.50

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 9 of 16MBSOnline

Anterior lumbar interbody fusion (ALIF), including XLIF or OLIF with (posterior) instrumented segmental fixation – single surgeonFusion at one motion segment:

51061 + 51160 (+ 51120)Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51061 Spine fusion, anterior and posterior, including spinal instrumentation at one

motion segment, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51062, 51063, 51064, 51065 or 51066 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.147

Multiple operations rule

Fee: $2,834.65Benefit:75% =$2,126.00

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51160 Anterior exposure of thoracic or lumbar spine, one motion segment, not

being a service to which item 51165 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.149

Multiple operations rule

Fee: $1,150.00Benefit:75% =$862.50

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 10 of 16MBSOnline

Fusion at two motion segments:51062 + 51165 (+ 51120)

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51062 Spine fusion, anterior and posterior, including spinal instrumentation at 2

motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51063, 51064, 51065 or 51066 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.147

Multiple operations rule

Fee: $3,674.35Benefit:75% =$2,755.80

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery Fee51165 Anterior exposure of thoracic or lumbar spine, more than one motion

segment, not being a service to which item 51160 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.149

Multiple operations rule

Fee: $1,450.00Benefit:75% =$1,087.50

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 11 of 16MBSOnline

Anterior lumbar interbody fusion (ALIF or XLIF or OLIF) with internal fixation – with assisting (access) surgeonFusion at one motion segment:

51021 + 51041 (+ 51120) Principle SurgeonGroup T8 – Surgical Operation Subgroup 17 – Spinal Surgery51021 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, one motion segment, not being a service associated with a service to which item 51020, 51022, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,281.20Benefit:75% =$960.90

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51041 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), one motion segment, not being a service associated with a service to which item 51042, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,082.70Benefit:75% =$812.05

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

51160 Assisting (access) surgeon

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51160 Anterior exposure of thoracic or lumbar spine, one motion segment, not

being a service to which item 51165 applies (H) (Anaes.) (Assist.) TN.8.141

Multiple operations rule

Fee: $1,150.00Benefit:75% =$862.50

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 12 of 16MBSOnline

Fusion at two motion segments:

51022 + 51042 (+ 51120) Principle SurgeonGroup T8 – Surgical Operation Subgroup 17 – Spinal Surgery51021 Fixation of motion segment with vertebral body screw, pedicle screw or

hook instrumentation including sublaminar tapes or wires, one motion segment, not being a service associated with a service to which item 51020, 51022, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.143

Multiple operations rule

Fee: $1,281.20Benefit:75% =$960.90

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51042 Spinal fusion, anterior column (anterior, direct lateral or posterior

interbody), 2 motion segments, not being a service associated with a service to which item 51041, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.145

Multiple operations rule

Fee: $1,515.80Benefit:75% =$1,136.85

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51120 Bone graft, harvesting of autogenous graft, via separate incision or via

subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.) TN.8.141

Multiple operations rule

Fee: $235.50Benefit:75% =$176.65

51165 Assisting (access) surgeonGroup T8 – Surgical Operation Subgroup 17 – Spinal Surgery Fee51165 Anterior exposure of thoracic or lumbar spine, more than one motion

segment, not being a service to which item 51160 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.149

Multiple operations rule

Fee: $1,450.00Benefit:75% =$1,087.50

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 13 of 16MBSOnline

Artificial lumbar total disc replacement (TDR) at one motion segment only – single surgeonTDR at one motion segment: 51130 + 51160

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51130 Lumbar artificial intervertebral total disc replacement, at one motion

segment only, including removal of disc and marginal osteophytes:

(a) for a patient who:(i) has not had prior spinal fusion surgery at the same lumbar level; and(ii) does not have vertebral osteoporosis; and(iii) has failed conservative therapy; and

(b) not being a service associated with a service to which item 51011, 51012, 51013, 51014 or 51015 applies

(H) (Anaes.) (Assist.) TN.8.141

Multiple operations rule

Fee: $1,793.65Benefit:75% =$1,345.25

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51160 Anterior exposure of thoracic or lumbar spine, one motion segment, not

being a service to which item 51165 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.149

Multiple operations rule

Fee: $1,150.00Benefit:75% =$862.50

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 14 of 16MBSOnline

Artificial lumbar total disc replacement (TDR) at one motion segment only – with assisting (access) surgeonTDR at one motion segment:

51130 Principle surgeonGroup T8 – Surgical Operation Subgroup 17 – Spinal Surgery51130 Lumbar artificial intervertebral total disc replacement, at one motion

segment only, including removal of disc and marginal osteophytes:

(a) for a patient who:(i) has not had prior spinal fusion surgery at the same lumbar level; and(ii) does not have vertebral osteoporosis; and(iii) has failed conservative therapy; and

(b) not being a service associated with a service to which item 51011, 51012, 51013, 51014 or 51015 applies

(H) (Anaes.) (Assist.) TN.8.141

Multiple operations rule

Fee: $1,793.65Benefit:75% =$1,345.25

51160 Assisting (access) surgeon

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51160 Anterior exposure of thoracic or lumbar spine, one motion segment, not

being a service to which item 51165 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.149

Multiple operations rule

Fee: $1,150.00Benefit:75% =$862.50

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 15 of 16MBSOnline

Artificial cervical total disc replacement (TDR)TDR at one motion segment: 51131 (+ 51011)

Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51131 Cervical artificial intervertebral total disc replacement, at one motion

segment only, including removal of disc and marginal osteophytes, for a patient who:

(a) has not had prior spinal surgery at the same cervical level; and

(b) is skeletally mature; and

(c) has symptomatic degenerative disc disease with radiculopathy; and

(d) does not have vertebral osteoporosis; and

(e) has failed conservative therapy

(H) (Anaes.) (Assist.) TN.8.141

Multiple operations rule

Fee: $1,082.70Benefit:75% =$812.05

+Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery51011 Spinal decompression or exposure via partial or total laminectomy, partial

vertebrectomy or posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142

Multiple operations rule

Fee: $1,435.50Benefit: 75% = $1,076.65

Medicare Benefits Schedule Spinal Surgery – Case example Guide Page 16 of 16MBSOnline